0001209191-14-012993.txt : 20140221
0001209191-14-012993.hdr.sgml : 20140221
20140221151800
ACCESSION NUMBER: 0001209191-14-012993
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140219
FILED AS OF DATE: 20140221
DATE AS OF CHANGE: 20140221
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CONCERT PHARMACEUTICALS, INC.
CENTRAL INDEX KEY: 0001367920
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 99 HAYDEN AVENUE
STREET 2: SUITE 500
CITY: LEXINGTON
STATE: MA
ZIP: 02421
BUSINESS PHONE: 781-860-0045
MAIL ADDRESS:
STREET 1: 99 HAYDEN AVENUE
STREET 2: SUITE 500
CITY: LEXINGTON
STATE: MA
ZIP: 02421
FORMER COMPANY:
FORMER CONFORMED NAME: CONCERT PHARMACEUTICALS INC
DATE OF NAME CHANGE: 20060628
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WAN MARK A
CENTRAL INDEX KEY: 0001190472
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633263
MAIL ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE RD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: THREE ARCH PARTNERS III LP
CENTRAL INDEX KEY: 0001256741
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633264
BUSINESS ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
BUSINESS PHONE: 6505298000
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: THREE ARCH ASSOCIATES III LP
CENTRAL INDEX KEY: 0001113520
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633265
BUSINESS ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
BUSINESS PHONE: 6505298000
MAIL ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JAEGER WILFRED E
CENTRAL INDEX KEY: 0001190474
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633266
MAIL ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE RD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: THREE ARCH MANAGEMENT III LLC
CENTRAL INDEX KEY: 0001256738
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633267
BUSINESS ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
BUSINESS PHONE: 6505298000
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2014-02-19
1
0001367920
CONCERT PHARMACEUTICALS, INC.
CNCE
0001256738
THREE ARCH MANAGEMENT III LLC
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
1
0
1
0
0001190474
JAEGER WILFRED E
C/O THREE ARCH PARTNERS
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
1
0
1
0
0001113520
THREE ARCH ASSOCIATES III LP
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
0001256741
THREE ARCH PARTNERS III LP
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
0001190472
WAN MARK A
C/O THREE ARCH PARTNERS
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
Common Stock
2014-02-19
4
C
0
13545
A
14854
I
See footnote
Common Stock
2014-02-19
4
C
0
18060
A
32914
I
See footnote
Common Stock
2014-02-19
4
C
0
3612
A
36526
I
See footnote
Common Stock
2014-02-19
4
C
0
251941
A
276295
I
See footnote
Common Stock
2014-02-19
4
C
0
335922
A
612217
I
See footnote
Common Stock
2014-02-19
4
C
0
67184
A
679401
I
See footnote
Common Stock
2014-02-19
4
P
0
5281
14.00
A
41807
I
See footnote
Common Stock
2014-02-19
4
P
0
98219
14.00
A
777620
I
See footnote
Series A Convertible Preferred Stock
2014-02-19
4
C
0
76531
0.00
D
Common Stock
13545
0
I
See footnote
Series B Convertible Preferred Stock
2014-02-19
4
C
0
102041
0.00
D
Common Stock
18060
0
I
See footnote
Series C Convertible Preferred Stock
2014-02-19
4
C
0
20408
0.00
D
Common Stock
3612
0
I
See footnote
Series A Convertible Preferred Stock
2014-02-19
4
C
0
1423469
0.00
D
Common Stock
251941
0
I
See footnote
Series B Convertible Preferred Stock
2014-02-19
4
C
0
1897959
0.00
D
Common Stock
335922
0
I
See footnote
Series C Convertible Preferred Stock
2014-02-19
4
C
0
379592
0.00
D
Common Stock
67184
0
I
See footnote
The Series A, Series B and Series C Convertible Preferred Stock converted into Common Stock on a 1-for-5.65 basis upon the closing of the issuer's initial public offering without payment of consideration.
These shares are owned directly by Three Arch Associates III, L.P. ("TAA III"). Three Arch Management III, L.L.C. ("TAM III") is the general partner of TAA III, and Wilfred Jaeger and Mark Wan, the Managing Members of TAM III, may be deemed to share voting and dispositive power over the shares held by TAA III. Such persons and entities disclaim beneficial ownership of the shares held by TAA III except to the extent of any pecuniary interest therein.
These shares are owned directly by Three Arch Partners III, L.P. ("TAP III"). Three Arch Management III, L.L.C. ("TAM III") is the general partner of TAP III, and Wilfred Jaeger and Mark Wan, the Managing Members of TAM III, may be deemed to share voting and dispositive power over the shares held by TAP III. Such persons and entities disclaim beneficial ownership of the shares held by TAP III except to the extent of any pecuniary interest therein.
Not applicable.
/s/ Wilfred Jaeger, as Managing Member of Three Arch Management III, L.L.C.
2014-02-21
/s/ Wilfred Jaeger
2014-02-21
/s/ Wilfred Jaeger, as Managing Member of Three Arch Management III, L.L.C., general partner of Three Arch Associates III, L.P.
2014-02-21
/s/ Wilfred Jaeger, as Managing Member of Three Arch Management III, L.L.C., general partner of Three Arch Partners III, L.P.
2014-02-21
/s/ Mark Wan
2014-02-21